The Blue Vet Diary

Looking back at the events of the last 2 weeks is leaving me stunned, when I see how much not only the life around me, but the world in general has changed and this will in many ways also affect the future content of this diary……but with this I will probably find myself in good company with my readers, where ever you are on the globe.

Driving further South while returning to the UK, I once again changed the operating theatre with the conference room for more Board and committee meetings with my other European Small Animal Veterinary colleagues. The meetings were hosted under a range of hygiene precautions (which appear inadequate, applying today’s requirements) in a huge cinema complex in Antwerp and coincided with the Belgian Small Animal Veterinary Congress.

Some of our colleagues had already declined the invitation, as they considered the journey as too much of a risk for their personal circumstances and indeed would a similar gathering not have been possible a week later. I am actually wondering how long it will now take, before we will be able to safely gather again in a similar setting…..

Following Antwerp and after having travelled nearly 13 000 km since the beginning of December, I finally arrived back home in the South of England.

Most of the next day was spend just with extracting all my stuff – which included not less than five sets of – unfortunately mostly unused – pairs of skis and a similar number of ski boots and running shoes – from my trusted carriage. I then even went so far as to afford a decent car wash, an expense which I had considered absolutely pointless while driving every day along untarmacked roads in Sweden. With a bit of soap and a lot of TLC the old BMW looked – nearly – like new again…..

Another country, another consulting room……

The friendly team in Abingdon, where I had worked already last November had requested my return and this time I was able to work out of their beautiful Didcot branch. Returning to exclusively English consultations, it took me a couple of days to catch up with all the things that had changed in my absence, getting to know new drugs and re-learning the names of familiar and not so familiar faces.

COVID 19 related health warnings were now a common feature and each client was vetted as a potential health risk before being allowed to enter the surgery. Appointments were more spaced out and hand disinfectants were used liberally.

Once I had got adjusted to my new/old working environment, the weekend arrived and Silke and I – following a detailed risk-benefit analysis (including a bottle of antipodean Sauvignon Blanc) – agreed to go on a pre-arranged trip to Bavaria, where a few nice and not so nice surprises awaited us…….

Driving South through Sweden and then – after travelling across the famous Öresund Bridge – passing Copenhagen and taking the long route over Sealand, Funen and then Jutland, I eventually entered home soil – Schleswig Holstein, the most Northern of the Federal States of Germany and the area where I grew up, where I went to school and where I saw veterinary practice for the first time in my life (and in fact didn’t particularly enjoy it….).

Arriving late at night in Kiel, the regional capital and also my home town, I found dinner and a bottle of wine prepared and some shelter for the night at the home of my childhood friends Andy and Stephan.

Sure enough there was a lot of catching up to do, but despite the fact that we all did not get much sleep that night, we were up early the next morning: my hosts to go to work and myself heading for one of my favourite places when at home – one of weekly markets, some selected shops and of course a couple places with excellent coffee.

The first of these came in form of a mini-van, right at the market and it gave both the customers as well as the market traders a quiet corner to relax and to have a chat in the morning sunlight.

Their coffee (or in my case latte) was in fact so good, that it had found recognition in a national gourmet magazine – what an excellent start of the day…..

Having stocked up on local honey and bread (we Germans are very particular about this….) I went to the old part of the town, where I visited three shops that are always on my list when passing by:

The first is an “old fashioned” music shop, which still sells CDs, but which just stocks quality sounds. This might include everything including and as diverse as the classics, Amy Winehouse, Maria Callas, the Buena Vista Social Club or the Choir of Young Believers.

Whenever I visit, I leave money there and I am introduced to new artists.

The next one is an antiquariat, which is still hanging in there selling historic volumes and maps. This time I took with me a couple of books which I had already seen on their shelves a few years ago and I knew that they were mine, but I had always refrained from buying them….. I visited them several times and found them well protected in a glass display cabinet, but no-one dared to touch (or better to buy) them – these books them to have known that I would return one day, to take them with me……

And finally I ended once again at Heyck, a bespoke tea and coffee retailer with a long tradition in Kiel – you can enjoy a freshly filtered cup, while they are grinding your coffee beans, pack your tea or wrap up the chocolate you just couldn’t resist to take with you on your journey. Basically a small piece of Heaven on Earth…….

Walking back to my car I couldn’t avoid taking a closer look at this street sign though…..

Even for someone not familiar with the German language, I think the message was clear, but what concerned me were the rules that would apply between 6 am and 9pm…….

As my time at a second vet clinic in Sweden is now coming to an end and I am leaving all my new friends in Kumla with a heavy heart, it is time to look back at a couple of months of – at times – hard work and long hours, treating my Nordic patients, but also at some other great things, I was able to do and which I have so far not shared with you.

One was in Grönklitt North of Mora after one of the few days of skiing I had, when I passed a musher and his sledge dog team. Turning my car around, I got out and ask for permission to take a few photos.

And as it often happens, when you talk to animal owners and it turns out that you are a vet, you might get on like a “house on fire”. No difference with Frasse and his dogs – he had just been at one of my local colleagues with his leading bitch after she had knocked out several teeth on her cage door. Although I couldn’t help him- or better – her a lot, I sympathized with him about the expected vet bill and agreed to contribute towards it by hiring his sledging team for a spin.

Good choice ! This experience was truly worth every penny – or better Kronor (no-one bothers about Öre any longer in Sweden….)! Seven huskies, that were rearing to run, took us through the woods and I had to admit, that although I came for cross country skiing, this was much better !!

My advice: If you ever get the opportunity to travel on a canine drawn sledge, take it – you won’t believe how much fun it is, especially if the dogs in front of you listen and are doing what they have been told to do……

Another highlight was to see in person the cross country skiing elite at the World Cup Races in Falun.

Although it might be for most of you a niche sport, I have been following these athletes on television for many years at night after work or on weekends, in my gym at home on the spinning bike, the in-door rowing machine or on other torture machines and in some way joined them during their races. Seeing them for real and witnessing their real speed and endurance added to my respect for these top athletes, in a similar way as you might respect and admire a world renowned artist, musician or scientist. Seeing the human body and/or mind at it’s peak is and always will be inspirational.

No-where much more so when seeing and admiring the endurance and raw determination of Therse Johaug, the by far best female cross country skier of our times (here unusually in the last position of a sprint semi-final, which is not really her event….)

Finally an experience I didn’t have……. – and to be honest, I am very glad about it.

Although I was doing my utmost to see an elk (running and driving at night, hiking through the forest and taking on purpose the “scentic routes”), sharing the front seats of my car with one, was clearly not on my wish list.

The image above was taken by my colleague, who had been offered a visit to the local driving school and an afternoon course on driving on ice, which is mandatory in the Scandinavian countries. The exhibits at the driving school were a stark reminder how dangerous it can be driving on Swedish roads.

And sure enough, how considerable the risk was, was demonstrated when one of the next mornings Ewa, one of our receptionists, arrived late for work after an female elk had virtually jumped on to her car. According to her, the car came out “second winner”….and the elk left a few souvenirs on the car windows before disappearing again into the forest.

So, while heading South and leaving Scandinavia – at least for now – the only encounter I had with an elk, is in form of a deep frozen filet, which was given to me by Leif, one of my Swedish colleagues, linked with the promise “to return back soon”…….

Ok, that doesn’t sound very sexy, but it was one of the reasons why I was so looking forward to working for a while in Scandinavia – I wanted to see at first hand how a far more reduced use of antibiotics in clinical practice can be achieved and how cases, where I normally would have used this form of medication are responding without them. Seeing is believing !…..

Let’s make one point clear though right from the onset: There is no doubt that we have been extremely lucky to live at a time where we can defend ourselves against bacterial infections which would with some certainty have killed us a hundred years ago. The availability of antibiotics has revolutionized both human medicine and veterinary medicine and even here in the Nordic countries no-one wants to imagine working once again without them.

However, in order to prevent resistances against antimicrobials, we have to use them more prudently. We need to choose the right kind of antibiotics for the right infections and we need to ask us constantly, if the use is necessary at all. This again goes hand in hand with excellent hygiene in all aspects of the treatment process.

There is no place in the world where this more strictly applied than in the Nordic countries and the results are striking:

Most small animal vets in the North are using less than 1/4 of the antibiotics than their counterparts in the South of Europe or in other parts of the world and the results at the clinics I have worked at, are even better.

So, how are they doing it ?

As mentioned above, it starts with good hygiene and this again begins with the right building and interior design. Most of the clinics here are purpose build and so designed that there are very few surfaces where dust and bacteria can accumulate.

This is then followed by clever storage solutions so that there is very little clutter.

Regular deep cleaning and alcohol bottles (which are used all the time) on every corner are also important features. In addition to this, all clinical employees are changing into scrubs when they enter the building and street shoes are left at the entrance. There has even been a call for mandatory showers before the change of clothes (something that is for many years the routine in large poultry and pig farms).

The next step is a change in the general mindset: in Scandinavia you nearly feel guilty if you dare to reach for the antibiotic bottle and if you do so, you are never using one of the critical antimicrobials which are reserved only for resistant infections or after confirming with an antibiogram that they are indeed the right choice.

Detaching the right to dispense antibiotics (and all other medication) from the right to use them and at the same time turning a profit from it, has also been discussed many times and personally I think that this is probably the right thing to do. Whenever follow on medication has to be given here in Sweden, I have to issue a prescription and the client has to collect the medication from a pharmacy. The downside of this system is that the clinical work becomes more expensive and a normal consult to see a vet is in the region of 80 Euros.

Compared with individual clinics like my previous one in Virginia Water, the large corporate organisations – like Anicura, who I am at the moment working for – have the advantage, that they can afford a clinical board that can work on the most up to date advice and they can employ someone to implement and to monitor the policy and they can produce the necessary data to back up the results.

While in Kumla I finally had the opportunity to meet one of these people: Ulrika Grönlund, the group’s Medical Quality Manager.

I have been in touch with Ulrika for many years in connection with the production of a set hygiene posters, which were written by a dedicated group of colleagues for FECAVA and which – in a range of different translations – are now hanging in veterinary clinics all over Europe and even in China. The working group , led by another Swedish colleague: Alex Vilen, had benefited from Ulrika’s advice especially when the posters were recently reviewed.

Although exchanging e-mails from time to time, I had never met Ulrika in person. In my first week in Kumla she happened to not only make one of her routine visits, checking on common hygiene problem areas using equipment from the food processing industry, where stands are even higher,

she also gave an evening presentation to the whole team, which – despite the fact that it was in Swedish – left me captivated (admittedly the power point slides helped considerably to understand what she was talking about….).

And indeed – over the last few weeks it has been a revelation for me to see, how many cases do well only with painkillers and often only with locally applied antibiotics and I will certainly take this knowledge back to my patients in the UK (and where ever else I am going to work).

Admittedly – to not appear too blue eyed about this issue – there are a few other reasons why vets in the North have it a bit easier to use less antibiotics: due to the colder climate and due to the interior design of Scandinavian houses (usually wooden floors with only a few soft furnishing elements) ectoparasits play a far smaller role. Another factor is the lower population density which also helps to reduce the infection risk. So moving up on a mountain and starting to shop at IKEA might not be such a bad idea after all!…….

Working night shifts for vets is a bit like Marmite – some colleagues love it, some loathe it…….

Working through the night (or part of it) is messing up one’s internal clock and it can be very disruptive for a “normal” family life. A busy night with a lot of emergencies or critical patients can be very draining and as night work is more likely to involve seeing very ill patients, the mental strain on the veterinary team can be considerable.

In the last few years of running my own clinic, I had progressively back away from additional night work as I could rely on the services of a dedicated night clinic fairly close by. Admittedly this was a godsend, as the double commitment with both the daily running of the clinic and of my involvement with FECAVA would have made it virtually impossible to provide also a decent night cover. I can re-call weeks when I got by with no more than 4 hours of sleep in a single night. Thankfully vets are always on their feet, so falling asleep while working was difficult……

Luckily though I am both a bit of a night-owl and I can function pretty well with very little sleep and then there is still the wonderful effect of a freshly brewed coffee…..

Working night shifts here in the North during the winter month is absolutely perfect for me: with work starting at 4 pm, I have enough time to stay long enough in bed in the morning, have time for a long run (ok – skiing would have been much better) and I still have time to see some of the towns and especially the beautiful countryside during day light. When the light is fading the work is starting.

When entering the clinic, most of the routine clients have been seen and you help with everything that is still to be treated and you familiarize yourself with the patients that will stay for the night. All the patients that are seen from now on are emergencies and you basically have to be prepared for everything….

At the same time the team is now reduced to just a handful of staff and in a larger place like Kumla, you never know who will be joining you this night. There is however always a strong camaraderie in the team – we are all in the same boat trying to steer it safely through the night and while sitting with a patient that is recovering from an operation or a patient having his seizures controlled, there is always some time to talk and to learn more about the people living in this part of the world, their background, their views of the place and their hopes and expectations. There is also usually the time to take a break, sitting together in a small group over a coffee and surely someone had brought along some food to be shared.

The consultations too I find more rewarding – the clients are understandably very worried about their pets and you can usually spend more time with them explaining why you do what. Some of my most memorable conversations with pet owners that I had in Virginia Water took place in the middle of the night while their dogs were recovering from cesarean sections, from gastric torsions or spleen ectomies.

Thankfully all my patients from last night are now back home with their owners, I had the pleasure making the acquaintance of a new canine member of the team and I even got a few hours of sleep……..the next night shift can come……..

Finally it was time to leave my little cottage in the woods and the three attention seeking feline tenants.

When signing up for the locum placement well before Christmas, I didn’t want to commit myself for more than a month to start with, just in case that the Nordic experience might not have turned out to be as great as it has been. This was not a problem, but the clinic in Falun had to make alternative arrangements for February and another colleague from the UK was on her way and she was looking forward to take over the responsibility for the cats and of course for the cottage as well…..

All my belongings had to be squeezed into the (no longer) white BMW and I realised that despite me living of porcini risotto with truffle oil from Italy, containers of apple juice from the Black Forest, sausages from the Alsace and wine from Austria and the Franken region in Bavaria, this had failed to free up any storage capacity. The fact that I had bought another set of skis and boots and had acquired a couple of new veterinary text books might have had to do with this……

Kumla is circa 200 km to the South of Falun, right in the middle between Stockholm in the East and Oslo in the West. The countryside here is less hilly and my chance for getting snow are reduced further.

However, here a busy veterinary hospital with circa 65 members of staff (2/3rds of the size of Falun) was waiting for me and instead of my little cottage, I now have a modern house on a lake which I am sharing with two other colleagues.

My new neighbor Peter is a petrol head being busy fitting tuned Volkswagen Beetle engines with 200+ BHP into beach buggies and he is the proud owner of an 8 kg + giant of a cat which understandably is ruling the neighborhood.

The team at the clinic in Kumla is more international than in Falun, with vets from France, Belgium, Romania, Australia and myself working alongside our Swedish colleagues. Once again I am blessed with a brilliant nursing team that is a delight to working together with.

Although I once again had to get used to a new computer system, it felt easier this time and I noticed that I have started to conduct more and more of my consultations in a mix of my resurfaced Norwegian and the native language. It just shows that the brain is very much like a muscle that can be trained, although it might be uncomfortable to begin with.

My work here is predominant emergency medicine, which includes presentations I have been less familiar with, like poly traumas due to wild boar attacks or lung oedemas in gun dogs.

Thankfully most patients have been luckier and are happy to stand for a photo.

Well, let’s see what the next three weeks will bring……

As alarming as this might sound especially to the Germanic ear, this is a very Swedish institution, the foreign traveler is introduced to shortly upon his/he arrival and this Nordic custom is one which even in our clinic in Falun is frequently enjoyed and which had its fixed place in the daily routine.

No, it is not what you might think………..

The “Fika” break, a time to calm down and to take your time for a relaxed cup of coffee (or tea) with friends or colleagues (or both), is an ever more important stress reducing exercise in the middle of the day (or at any time during the day) which is now also utilized by forward thinking large companies.

The name “Fika” resulted from a word play, where the two syllables of “Ka-fee” are exchanged and slightly tweeked. The first mentioning of the word dates back just over a hundred years but that means a lot of coffee cups (!)………

My hosts were in this matter preaching to the converted – although I loved spending time in my clinic in Virginia Water with my team, I always tried to break away at least for a short time to one of the local coffee chains in the UK to meet of a coffee and a sandwich with friends, to have a quiet read though the daily newspaper or just for a quick caffeine fix. Knowing now how serious this habit is taken in other countries, makes me with hindsight feeling far less guilty.

So – when have you had your last “Fika” ?……

Ok, ok……it is not quite as bad as it sounds, but it is absolutely true.

At least when we are talking about cash: I don’t have a single Swedish Kronar in my pocket and this is the case since my arrival in Sweden a month ago. I don’t even know how the local currency looks and feels like….

The reason for this is, that it is virtually impossible in some places to pay with cash and even where it is, people are not particularly happy with you if you try to do so. Even some larger shops like IKEA have gone completely cashless in some of their branches (tough luck if you have collected all your items for the last 2 hours and end up with only cash in your pocket at the till….)

Sweden , similar to some other Nordic countries, is – seemingly very successfully – trying to go cashless. Virtually everywhere and even for the smallest amounts you can pay with your credit card or with “Swish” , a local sort of debit card for which you need a Swedish bank account though (I think….).

Some Swedes have gone so far that they have been implanted with a microchip that enables them to make digital payments where ever they go. This – I would say – takes it a bit too far for me….

So, don’t rush to bail me out or to send me any food parcels – although I don’t have any coins or notes in my pocket, I am still doing fine.

However, I am not looking forward going through my credit card statement at the end of the month, especially as I am using a German credit card with the bank adding a foreign exchange fee to each transaction.

Well, this little chap has offered to help me….

This morning I woke up by being “head butted”…..

Something that came along with the job in Falun was the opportunity to stay in a 17th century log cottage on the farm of Anna – one of my colleagues – and her husband.

What I had not been told, was that there were three other tenants : Yoda, Swerre and Bamse – the farm cats – who turned out to be very social and who frequently tried to occupy the most comfortable seats in the house, the bench in the kitchen or my bed….

Thankfully the headbutting issue was quickly resolved by letting the culprit go outside. It wasn’t helped though that it was 6 am and -5C and it didn’t feel much warmer inside the cottage…..

Nevertheless, the place was absolutely perfect for me and I loved it from the first moment: two rooms – a kitchen with a large fridge and a couple of bunk beds and a living room with another two beds offered enough space for myself, for all the stuff I had taken with me in my long suffering car and for the three felines. There was also a bathroom with well working underfloor heating and a utility room with a washing machine and a tumble dryer.

The place is circa 10 km away from the clinic, in the middle of the nowhere, surrounded by forest and fields, with grazing horses and the occasional elg (ok, I haven’t seen one yet, but I have been told that they are out there…..)

Vital tasks to learn were to chip wood in the correct way with a special blade to light a fire in the tiled fire place without using any paper and to turn on the timer first, when trying to warm up food on the heating plates – failing to do this, resulted a few times in a freezing bedroom or in a cold supper or in both.

Close to the cottage in a disused railway line (with the tracks and sleepers removed), which makes a nice and flat running track when I am coming home from work, which is always at night (which starts here at 3.30 pm).

Completing my humble abbot is a well stocked library, containing a nice selection of the works of Agnes von Krusenstjerna, Selma Lagerloef and August Strindberg and many more of the Swedish classics, but unfortunately all in Swedish……

However – how simple can a piece of paradise be?…….

Today I like to take you on an early morning run through “Lock Down” Oxford on a Sunday morning after – thankfully – a quiet night on call.

It won’t be a fast run, because we will stop frequently to take a look at some well known historic sights, but also at some less obvious features I have spotted this morning, which are easy to overlook, but which I find so typical for the British sense of humor or way of life…..

Starting right at the clinic in Iffley Road, it doesn’t take you long (in fact just to the other side of the road….) to realize that running has had a rather famous tradition here …….

Roger Bannister’s ground breaking sub 4 minute mile at the University’s Sports Fields was another inspiring events of that time, following the successful ascent of Mount Everest the previous summer. Clocking double the time per mile when I am out for a run is giving me a rough idea of this achievement (and I have no idea what today’s record is….).

Continuing at snail pace (….) away from Magdalen Bridge, I am heading for the Thames and I am crossing the river at Weir’s Lane, joining the towpath just as the sun is rising.

Kanal boats and famous rowing clubs are the main feature here

and the meadows give a sense of tranquility despite their proximity to the city center.

Soon the famous “Head of the River” public house comes into sight

and I am crossing the river again to head for the historic part of Oxford.

Christ Church and Merton College and Merton Field are normally tourist magnets, but this morning I have these quintessential Oxfordian institutions just for myself…

While running through the smaller lanes and alleys, the writing on an ATM machine is catching my eye:

“TLC not PLC”…..not sure if that is true, but at least it is a nice touch and it is an example to look for the little things in life that can make a difference to a whole day.

Other places I am passing that make me smile are the Three Goats Heads Pub (heaven knows where this name comes from……)

and the very contemporarily named “Nosebag Restaurant”

which then turns out to have a somewhat boring explanation for its name……

Heading down Broad street leaving the Sheldonian Theatre on my right

I am running along Catte Street right between the Bodleian and the Codrington Libraries and have another stop at the Radcliffe Camera.

Other than a few cyclists and some early morning runners like me, there is absolutely no one in sight….

I also realize that Sir Edmond Halley appears to have had a very short way to work …….

My memories go back to 1986 when I had the great fortune to see the comet with my own eyes in Alice Springs. I am wondering though if I will get a second chance…….

Rather than continuing on the High Street to return to the clinic, I decide to take another detour back into the historic heart of the city and not far away from the Bridge of Sighs

I am paying Oxford’s oldest pub , the somewhat hidden “Turf Tavern” a brief visit.

Obviously closed – not only because of the pandemic – at this time of day, it appears that here a lot of famous drinkers must have had a good time…..

This beautiful sculpture at the chapel of Queen’s College

demands a final stop, before I am aiming for the familiar sight of “The Cape of Good Hope”

and the “other” Oxford (see my last post) at Iffley Road.

How do you feel ? Did you enjoy our run ?!…….